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CHAIN-OF-CUSTODY 1 Analytical Request Document <br /> 1!;IaceAnalyfical The Chain-of-Custody Is a LEGAL DOCUMENT All relevant flelds must be completed accurately <br /> 579895 <br /> Aequlred Client Information Section A Required Client information Section B Pale of At I To Be Completed by Pace Anafyboal and Client Section C t <br /> Company ` y Re rt To Quote Reference <br /> Gmhl /ivi Client Information Check uotelcontract <br /> Address6,2 I iceA, Requested Due Date T Protect Manager <br /> � V � <br /> P O *Tum around bmes less than 14 days subject to Project# <br /> V! f tt[ V laboratory and contractual obligations and may result in a <br /> di <br /> PrgW Name Rush Turnaround Surcharge Profile# <br /> =I! Tum Around Time(TAT)on calendar days � <br /> Phoneq� Fax Pro ec1 Number Requested Analysis <br /> 11a� Q <br /> Section D Required Client Information Valid Mat Codes p o Preservatives ry� <br /> MATRIX coot: w w <br /> WATER WT ww C~J w V <br /> SAMPLE ID SOOIL OIL L 0 0� J <br /> WIPE wP x O O a d <br /> One character per box AIR AR LL U U 2 m ~ _ 0 <br /> W (A-Z,0-9 P-) TISSUE TS Q 0 c N z U Q ti Q v <br /> F Sample Iqs MUST BE UNIQUE OTHER oT mm 1 dd l yy hh mm alp a Z) 3: 2 z z z Remarks I La--rD <br /> 710 a I <br /> f"k <br /> s'.'a"t� r �e +f}a • - xy 4 g yz�'a �_J !'� b Z59 <br /> �f// <br /> V <br /> a ri r t' O � <br /> r <br /> a �� trT e �� alo3r� V { r' Q <br /> h <br /> InN <br /> 4e ed <br /> p Q><n <br /> S a rtrh !anal <br /> 6A. Relinquished Ely Company DateJ I Accepted By Company Date Time <br /> OF J <br /> Temp In°C VAd ` <br /> 'tJ# <br /> Received on ICE 1 N <br /> Sealed Cooler 1 N <br /> Samples intact <br /> Additional Comments SAMPLER NAME AND SIGNATURE <br /> PRIN Name of SAM R i <br /> l <br /> SIGNATURE of SAM DATE Si ed PM Do!YY) <br /> 1 <br /> SEE REVERSE SIUOR INSTRUCTIONS Pace Analytical Services, n rm C0001 02100 <br /> nRIGINAL <br />